Credit Card Payment Authorization Form

I hereby authorize Girl Scouts of Manitou Council to charge my credit card for the donation/pledge I am making to the council.

The amount of the donation will be $
effective (date)
The frequency of the charge of this amount will be:
One Time
Monthly
Quarterly
Annually

Except for one time donations, this authorization will remain in force until Girl Scouts of Manitou Council receives written notification from me of its termination. I may revoke this authorization at any time.